Cost Curve News

A Must-Read Bloomberg Piece on Gene Therapy Highlights the Biggest Dilemma in Pharma

 

Inflection Point

The thorniest problem in biopharmaceuticals is the growing conflict between cost-effectiveness and budget impact. In other words, we increasingly have weapons against disease that are, objectively and mathematically, a good deal, but we don’t necessarily have the money to pay for them.

To rip off Matt Herper: it’s a terrible Zen koan.

All of that is organ music for this plea: block out a chunk of your day to read Lisa Jarvis’ exhaustive look in Bloomberg at the complexities of how we pay for (or don’t!) gene therapies. Lisa’s reporting makes clear that there are no easy answers, though I’m interested in her suggestion that the government ought to prop things up while we work through the problem.

One of the real risks, if we can’t figure this out, is that society just stops incentivizing this kind of innovation. We’re headed in that direction now, as this STAT story from this morning makes clear. Early-stage companies in the cell and gene therapy space are really having issues.

It’s incredibly important not to think of the good-deal-yet-can’t-afford problem as solely a gene therapy thing, though. This may be the framing that we see around Alzheimer’s medicine. It’s absolutely going to be the philosophical issue around obesity meds.

As I’ve noted before, Americans are terrible at thinking through tradeoffs. There is no iron law that says that we can’t, as a society, shift spending from low-value services to high-value ones, but — in practice — that’s been an enormously hard nut to crack.

And it gets even harder when that debate starts going beyond health. Should we cut defense spending to ensure universal coverage of Alzheimer’s medicines? Cut agricultural subsidies to get more people on obesity drugs?

But we’re going to have to start figuring out how to have those conversations or else we’re going to end up making a bunch of decisions that hurt our health in the short term and our wallets in the long run.

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